Helmets Linked to Reduced Head Injury Risk in Alpine Sports

Skiers and snowboarders have a significantly lower risk of head injury when wearing a helmet, a meta-analysis showed.

Action Points

Explain to interested patients that this study could not prove a causal relationship between helmet use and risk of head injury.

Skiers and snowboarders have a significantly lower risk of head injury if they wear helmets, a meta-analysis showed.

In a pooled analysis of nine studies, helmet wearers were 35% less likely to suffer a head injury than those without helmets (OR 0.65, 95% CI 0.55 to 0.79), Brent Hagel, PhD, of the University of Calgary in Alberta, and colleagues reported online in the Canadian Medical Association Journal.

The association was significant for skiers and snowboarders alike.

Although there has been some concern that use of a helmet could increase the risk of neck injury because of the extra weight it adds to the head, especially with children, the studies did not confirm any danger.

"Based on our findings, we encourage the use of helmets among skiers and snowboarders," the researchers wrote.

Various reports have estimated that 9% to 19% of injuries that occur on the slopes are head injuries and 1% to 4% are neck injuries.

Traumatic brain injury is the leading cause of death and serious injury among skiers and snowboarders.

A recent example was the training accident of U.S. Olympic hopeful snowboarder Kevin Pearce, who suffered a severe traumatic brain injury when he fell and hit his head on the edge of a half pipe on New Year's Eve. He was wearing a helmet.

Although injury prevention efforts in alpine activities have focused on helmets, there were no systematic reviews of their effectiveness, the new study's authors noted.

So Hagel and colleagues assembled data from 10 case-control studies, one case-control/case-crossover study, and one cohort study, totalling 9,829 participants who were wearing helmets and 36,735 who weren't. The studies evaluated head injury, neck injury, or both.

In addition to protecting adults from head injury, the researchers found, helmets also appeared to protect children younger than 13 (OR 0.39, 95% CI 0.23 to 0.65).

While two of four studies looking at potentially severe head trauma -- resulting in referral to an emergency physician or hospital for treatment or evacuation by ambulance -- found a reduced risk in those wearing helmets, the other two found no effect.

There was some evidence that risk of head injury was reduced for males wearing helmets, but not for females, although sex was not found to be a significant modifier of the relationship between helmet use and injury risk (P=0.09).

Helmet use was not associated with risk of neck injury, even among children, which "is consistent with biomechanical data showing no increase in neck loads associated with helmet use in simulated snowboarding falls," the researchers noted in the journal.

The meta-analysis had some limitations, they wrote, including the moderate methodologic quality of the included studies, two different approaches for determining control groups (noninjured skiers and snowboarders versus those with injuries not involving the head or neck), the inclusion of English-language studies only, and variations in confounders, definitions of head injury, and places of and personnel involved in diagnosis.

In addition, the researchers were unable to examine the results in terms of the design, quality, or fit of the helmets for cases.

"Methodologically rigorous research is required to determine which types of helmets provide the best protection," they wrote.

No external funding was received for the study.

Hagel holds the Alberta Children's Hospital Foundation Professorship in Child Health and Wellness, funded through the support of an anonymous donor and the Canadian National Railway Company. He also holds a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research and a New Investigator Award from the Canadian Institutes of Health Research.

One of his co-authors holds a doctoral studentship from the Alberta Heritage Foundation for Medical Research.

POPULAR IN YOUR SPECIALTY

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.